2020 Formularies
Comprehensive Formulary 2020 | Formulary Link for 2020

2021 Formularies
Comprehensive Formulary 2021 | Abridged Formulary 2021 | Formulary Link for 2021

  • Instructions on how to Find a Drug on the Formulary (click here)

Request a Formulary


What is the Passport Advantage (HMO SNP) Formulary?

A formulary is a list of covered drugs selected by Passport Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Passport Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Passport Advantage network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

 


For the 2020 list of covered Diabetic Supplies and Pen Needles for Passport Advantage (HMO SNP), click here.

For the 2021 list of covered Diabetic Supplies and Pen Needles for Passport Advantage (HMO SNP), click here.


As a member of Passport Advantage, you are eligible to receive a monthly allowance of $20.00 in select Overthe-Counter (OTC) products up to the allowable benefit amount. In 2021, we have extended our monthly allowance to $40 per month.

OTC medications are trusted as a first line of defense in treating minor ailments, help reduce doctor visits and save you money. Passport Advantage is committed to providing this program to you as a benefit to help you live a healthy lifestyle and improve the quality of your life.


The following categories are available with our OTC program:

  • Adult Care
  • Cough/Cold/Allergy
  • Digestion/Laxatives/Antacids
  • Ear & Eye Care
  • First Aid
  • Oral/Dental Care
  • Pain Relief
  • Vitamins

View the 2020 Over-the-Counter (OTC) Catalog for the full listing click here 

View the 2021 Over-the-Counter (OTC) Catalog for the full listing click here

To order online, click here

For the 2020 FAQ, click here

For the 2021 FAQ, click here

 

 

 

 

 

 

 

 

 

Last Modified: November 17, 2020